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THE EFFICIENCY OF KINEZITHERAPY IN THE TREATMENT OF THE CLUBFOOT TILL THE SURGICAL PERIOD. SUMMARY Clubfoot – is one of the common congenital deformation of skeleton-muscular system, wich requires active treatment. It is one of the most frequent reasons for phisical incapability. The incidence of clubfoot is approximately 1-2 cases per 1000 live births in the world, and 2 cases per 1000 – in Lithuania. 80 % of those cases are diagnosed in less economically developed countries. The problem is relevant because investigators present different outcomes of treatment. We couldn’t find any articles about kinezitherapy treating this deformation. The aim of the objective was to evaluate the efficiency of kinezitherapy in the treatment of clubfoot till the surgical period. In order to achieve this object the following tasks were set: To compare the function of the foot before and after kinezitherapy correction. To identify parients opinions about the changes of the function of the foot. To identify medical opinion about the changes of the function of the foot till the surgical period. Investigation included 8 children with clubfoot deformity before eight months of age. The function of foot was evaluated by thr method of goniometry. Also, the qualitive research was done by the method of phenomenography. In the qualitive research 3 parients of children and one doctor were included. After analysis done by mathematical statistics method the folowing conclution was done: After kinezitherapy... [to full text]

Clubfoot is a developmental defect of the lower limb that affects as many as 1 in 500 births across Scotland (Miedzybrodzka., 2003). How the clubfoot defect arises during embryonic development is not known, although a number of tissue abnormalities have been postulated to be the primary abnormality in the development of the clubfoot defect. A chick model of clubfoot was created to investigate the developmental basis of clubfoot. Using a method modified from previous work carried out by Germiller and co-workers (1998), clubfoot was induced in the chick embryo using the pharmacological agent decamethonium bromide. The defect was confirmed to be clubfoot by comparing the features observed in the chick hindlimb with characteristic features observed in human clubfoot. By analysing the development of the hindlimb muscle, nerves, skeleton, tendons and vasculature the primary defect was found to be a loss of muscle in the hindlimb resulting from both an increase in apoptosis and a decrease in muscle differentiation. This resulted in a loss of muscle-nerve branches, which were found to regress in the absence of muscle, and tendons which were either missing or abnormally positioned. The vasculature in the clubfoot limb appeared grossly normal. A number of environmental causes of clubfoot cause a compression of the developing embryo, for example a reduction in the volume of amniotic fluid surrounding the embryo, physically compresses and immobilises the embryo. To investigate this, the amniotic fluid was removed from around chick embryos and was found to cause clubfoot. The primary abnormality was found to be a loss of muscle in the hindlimb. Thus, it has been demonstrated that clubfoot, induced both pharmacologically and physically, results primarily from a loss of muscle in the hindlimb. During embryonic development, the hindlimbs are required to rotate. It was found that this process was disrupted in chick clubfoot providing evidence for the long-standing theory (Bohm., 1929) that disrupted hindlimb rotation may underlie clubfoot. It is suggested from the data in this study, that a loss of hindlimb muscle disrupts the process of rotation and thus the feet remain unrotated, resulting in clubfoot.

The present study is focused on understanding the aetiology of the human clubfoot deformity. Although this pathology has been studied since Classical Antiquity, the mechanisms that lead to this abnormality in new-born patients remain elusive. Clubfoot is a deformity of one or both feet present at birth, in which the foot is abnormally positioned in a hand-like position, that is, the foot is turned and rotated inwards while pointing down; and is resistant to any further movements. Very little is known about the aetiology and genetics of clubfoot in the human population. Only recently, mutations in the PITX1 gene have been associated with a small number of patients. Because the genetic basis is not understood and the phenotypic observations are complex and variable in human patients, many mechanisms have been proposed to explain clubfoot. In this study, these pressing questions were addressed using the peroneal muscular atrophy (pma) mouse, a spontaneous mutant that has been shown to be a surprisingly good model for clubfoot, recapitulating the key features of the human phenotype. In order to confirm that the pma mouse is in fact an idiopathic model of clubfoot, it was important to understand if the pma clubfoot-like phenotype occurs in isolation or within a syndromic pathology. In addition to clubfoot, it was found that these animals show a retinal degeneration phenotype. However, this phenotype was associated with the Pde6brd1 mutation, suggesting that clubfoot occurs independently of the retinal phenotype and thus the pma is a good model for human idiopathic clubfoot. Clubfoot in the pma mouse has been associated with the observed failure of the foot rotation during embryonic development. This defect is thought to result from the extensive regional muscular atrophy that occurs at earlier stages. The peroneal nerve is also absent in the adult pma mouse, a defect that has remained unexplored. As such, this neuronal defect was studied to understand the reason for the peroneal nerve absence in the adult animals. The results indicate that the nerve fails to branch from the developing sciatic nerve during embryogenesis and is unable to innervate its target muscles. This abnormal branching process is associated with a neural growth delay. In respect to the genetics of the pma, it was not possible to identify the exact mutation that is responsible for the inheritance of the clubfoot phenotype. However, strong evidence was found in favour of a regulatory mutation resulting in over-expression of the gene Limk1, which encodes for a kinase involved in neuronal guidance and growth. Further work was performed on chicken embryos to understand the foot rotation process. By removing defined regions of muscle tissue from the developing limb zeugopod, it was possible to conclude that lack of function of the anterior and lateral hindlimb tissue is associated with abnormal foot rotation, resulting in a similar phenotype to clubfoot. By examining the affected muscles, it was possible to identify the tibialis cranialis and the peroneus longus muscles as relevant candidates involved in clubfoot aetiology. In summary, the evidence presented here suggests that the pma clubfoot results from a regulatory mutation that induces Limk1 over-expression and nerve growth delay. This in turn prevents the proper development of the peroneal nerve, resulting in the degeneration of its target muscle tibialis anterior and peroneus longus muscles. This degeneration will interfere with foot rotation and result in clubfoot. Thus, the results described by this work are of utmost importance for the understanding of the clubfoot pathology, as it supports a neuro-muscular aetiology dependent on a physical dynamic equilibrium of muscular forces. This is of scientific interest as it expands the current understanding of the foot rotation and the integrative interactions during the limb organogenesis; poorly described developmental processes, and of clinical relevance as it establishes important ideas and concepts for study in human patients.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Clubfoot is one of the congenital and structural conditions that lead to physical impairment in children globally. Service providers have different perceptions on the various methods of management of clubfoot. This has led to adoption of various approaches of management of clubfoot. Although there is a wide range of experiences of parents/caregivers of children with clubfoot regarding medical management of this condition, there is no documented data on these experiences. The study therefore aimed at exploring the perceptions regarding the medical management of clubfoot in Kenya. The objectives of this study were to explore the service providers and parents/caregivers perceptions on the use of the different methods of medical management of clubfoot; explore the process followed before and after the commencement of management from the service providers and parents/caregivers when using surgical and conservative methods of management as well as exploring the barriers and enabling factors that the service providers experience during the management of clubfoot. Methodology: This study was conducted at talipes clinic of Mbagathi District Hospital, Kenyatta National Hospital and Kijabe Mission Hospital in Kenya. The study utilized a qualitative design and purposive convenient sampling was utilized to recruit participants. Twenty participants were recruited; the sample consisted of ten parents/caregivers of children with clubfoot and ten service providers. Semi-structured interview and probes were used for data collection, interviews were audiotaped and a research assistant took notes, data was collected until saturation. Data was transcribed verbatim and analyzed by thematic-content analysis. The results indicated that most of the service providers perceived Ponseti method as the most effective method of clubfoot management with early intervention. Surgery was found to be the second most utilized method which was indicated for complex and neglected clubfoot. The factors that affected service providers in clubfoot management included: Shortage of trained staff in Ponseti management, missed diagnosis at birth; poor referral system and poor compliance with treatment appointments. The factors that affected parents/caregivers compliance with the treatment regime included: (i) unaffordable transport expenses; (ii) long distance; (iii) little or no social/family support; culture/tradition and stigmatization while compliance was facilitated by (i) good communication between the parents/caregivers and the clinician; (ii) availability of free services (iii) social/ family support. Conclusion: The current study concluded that medical management of clubfoot was a success while majority of parents/caregivers agreed that they were faced with several challenges as fore mentioned which affected the outcome. Recommendation: the study therefore recommends the need to empower the community and service provider with knowledge on clubfoot and its management. There is also need for decentralisation of services and increase the number of health care givers in health facilities who are trained in clubfoot management. Finally physiotherapy academic institutions need to put emphasis on teaching clubfoot management in order to produce effective service providers.

Thesis (MMed)--Stellenbosch University, 2014. / No abstract available

O pé torto congênito (PTC) é a deformidade congênita de maior prevalência na ortopedia. No Brasil, cerca de 2:1000 nascidos vivos são acometidos por essa malformação. As deformidades fundamentais são adução, e supinação do antepé, varo do calcâneo, equinismo na articulação subtalar. O tratamento pode ser cirúrgico ou conservador e deve ser iniciado o mais cedo possível. Os métodos biomecânicos descrevem o movimento das estruturas do aparelho locomotor durante as atividades funcionais. O objetivo geral desta pesquisa de mestrado foi realizar a análise cinemática dos movimentos entre o antepé e o retropé de crianças com pé torto congênito, tratadas pelo método Funcional Francês Adaptado. Para isto foram avaliadas 7 crianças com idades entre dois e 8 anos por meio de quatro câmeras filmadoras digitais que gravaram os deslocamentos de marcadores colocados em pontos anatômicos dos membros inferiores durante a fase de apoio e balanço da marcha em velocidade auto selecionada. Posteriormente os pontos foram digitalizados, a reconstrução tridimensional e o calculado dos ângulos de Euler foram feitos por meio do programa Matlab. Os movimentos de pronação/supinação, dorsiflexão/flexão plantar e abdução/adução destes dois segmentos do pé destas crianças foram comparados com crianças com desenvolvimento típico. Apenas o movimento de pronação/supinação do retropé foi igual entre as crianças com desenvolvimento típico e crianças com pé torto congênito. Este é o primeiro estudo que mostra como se comportam os movimentos do antepé e retropé de crianças com pé torto congênito, durante a marcha em esteira. Estes resultados são importantes, pois auxiliam a compreender compõem um estudo pioneiro na identificação da mobilidade do pé durante a marcha em crianças com pé torto congênito / Congenital clubfoot (PTC) is the most prevalent congenital deformity in orthopedics. In Brazil, about 2: 1000 live births are affected by this malformation. The fundamental deformities are adduction, and supination of the forefoot, varus of the calcaneus, equinism in the subtalar joint. Treatment may be surgical or conservative and should be started as soon as possible. Biomechanical methods describe the movement of structures of the locomotor apparatus during functional activities. The general objective of this master\'s research was to perform the kinematic analysis of walking of children with congenital crooked feet. Seven children aged between two and eight years were evaluated through four digital camcorders recording the displacements of markers placed in anatomical points of the lower limbs during the support phase and self-selected speed gait. After the points were digitalized, the three-dimensional reconstruction and the Euler angles calculation were done through programming routines written in Matlab. The pronation / supination movements, dorsiflexion / plantar flexion and abduction / adduction of these two foot segments were compared with children with typical development. Only the pronation / supination movement of the hindfoot was the same among children with typical development and children with congenital crooked feet. This is the first study that shows how the movements of the forefoot and hindfoot of children with congenital clubfoot behave during treadmill walking. These results are important because they help to understand the joint mobility of the feet of children during gait and to contribute to the treatment of patients with congenital clubfoot

Purpose: To highlight the histopathological characteristics of the skin in congenital clubfoot and correlate the clinical findings in clubfoot with the changes in the dermal layers. Materials and methods: One hundred skin specimens, from 77 infants (6 to 12 months), were studied between 2004 and 2008. Using the Pirani scoring system, the clinical severity was recorded. The mobility of the skin and the correctability of the medial ray were assessed clinically. A skin specimen (1cm x 1mm) was taken from the medial side of the foot at surgery following failed plaster treatment. The layers were studied under light microscopy. The thickness of the dermis and the histopathological features of clubfoot skin were compared with 10 normal skin specimens. Results: The dermis of clubfoot skin showed significant fibrosis with thick bundles of collagen fibres (P = .001) on Haematoxylin and Eosin staining (H&E). The dermal thickness ranged between 1.0mm and 5.2mm in clubfoot skin, compared with controls (0.64-1.28mm). Fibrosis extended into the subcutis in a septolobular fashion in 95% of the cases. Significant atrophy of eccrine glands was seen in 98% (P = .001). Hair follicles were absent in 78%. The elastic fibres of clubfoot skin, stained with Elastic van Gieson staining (EVG), showed hypertrophy in varying degrees in all skin specimens. They were fragmented, with loss of their parallel arrangement. There was no significant inflammatory reaction in the dermis. The Pirani score was significantly increased (mean 7.8). Discussion: Fibrosis and thickening of the dermis were the most significant histopathological features of the clubfoot skin. The elastic fibres were also abnormal. There was atrophy of the skin appendages due to the fibrosis. There was a strong correlation between the Pirani score and the severity of the deformity(P 0.016). The cases with poor outcome had a higher score than those with a satisfactory outcome.Lack of a significant inflammatory reaction suggests that neither the serial manipulations of the foot, nor the repeated plaster cast changes, were responsible for the dermal fibrosis, which is probably present from birth and contributes to the deformity. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2012.

O pé torto congênito (PTC) é a deformidade congênita de maior prevalência na ortopedia. No Brasil, cerca de 2:1000 nascidos vivos são acometidos por essa malformação. As deformidades fundamentais são adução, e supinação do antepé, varo do calcâneo, equinismo na articulação subtalar. O tratamento pode ser cirúrgico ou conservador e deve ser iniciado o mais cedo possível. Os métodos biomecânicos descrevem o movimento das estruturas do aparelho locomotor durante as atividades funcionais. O objetivo geral desta pesquisa de mestrado foi realizar a análise cinemática dos movimentos entre o antepé e o retropé de crianças com pé torto congênito, tratadas pelo método Funcional Francês Adaptado. Para isto foram avaliadas 7 crianças com idades entre dois e 8 anos por meio de quatro câmeras filmadoras digitais que gravaram os deslocamentos de marcadores colocados em pontos anatômicos dos membros inferiores durante a fase de apoio e balanço da marcha em velocidade auto selecionada. Posteriormente os pontos foram digitalizados, a reconstrução tridimensional e o calculado dos ângulos de Euler foram feitos por meio do programa Matlab. Os movimentos de pronação/supinação, dorsiflexão/flexão plantar e abdução/adução destes dois segmentos do pé destas crianças foram comparados com crianças com desenvolvimento típico. Apenas o movimento de pronação/supinação do retropé foi igual entre as crianças com desenvolvimento típico e crianças com pé torto congênito. Este é o primeiro estudo que mostra como se comportam os movimentos do antepé e retropé de crianças com pé torto congênito, durante a marcha em esteira. Estes resultados são importantes, pois auxiliam a compreender compõem um estudo pioneiro na identificação da mobilidade do pé durante a marcha em crianças com pé torto congênito / Congenital clubfoot (PTC) is the most prevalent congenital deformity in orthopedics. In Brazil, about 2: 1000 live births are affected by this malformation. The fundamental deformities are adduction, and supination of the forefoot, varus of the calcaneus, equinism in the subtalar joint. Treatment may be surgical or conservative and should be started as soon as possible. Biomechanical methods describe the movement of structures of the locomotor apparatus during functional activities. The general objective of this master\'s research was to perform the kinematic analysis of walking of children with congenital crooked feet. Seven children aged between two and eight years were evaluated through four digital camcorders recording the displacements of markers placed in anatomical points of the lower limbs during the support phase and self-selected speed gait. After the points were digitalized, the three-dimensional reconstruction and the Euler angles calculation were done through programming routines written in Matlab. The pronation / supination movements, dorsiflexion / plantar flexion and abduction / adduction of these two foot segments were compared with children with typical development. Only the pronation / supination movement of the hindfoot was the same among children with typical development and children with congenital crooked feet. This is the first study that shows how the movements of the forefoot and hindfoot of children with congenital clubfoot behave during treadmill walking. These results are important because they help to understand the joint mobility of the feet of children during gait and to contribute to the treatment of patients with congenital clubfoot

L’examen clinique et les radiographies standard des membres inférieurs et des pieds comportent des biais liés à la reproductibilité et à la projection en 2 dimensions d’unobjet en 3D. La reconstruction en 3D des segments anatomiques à partir d’images biplanes acquises en position debout doit permettre de s’affranchir de ces biais, au prixd’une irradiation modérée. La 1ère partie de ce travail a posé la question de l’utilisationen pratique clinique courante des reconstructions en 3D issues de ce système, et a permis de valider la reproductibilité de celles ci ainsi que de donner des valeurs de référence de ces paramètres mesurés en 3D. La 2ème partie a consisté en l’adaptationd’un modèle de reconstruction de pieds de l’adulte à ceux de l’enfant, a permis devérifier la reproductibilité des données obtenues, ainsi que de rapporter des valeurs préliminaires de paramètres de mesures radiologiques. Enfin, la 3ème partie a étudié l’analyse complète de pieds pathologiques (pied bot varus équin) associant l’examenclinique, la morphologie radiologique (obtenues par EOS®) et la fonction du pied lors d’une analyse de la marche. Nous en concluons que si cette analyse combinée paraîtcapitale, des difficultés persistent, en particulier dans le choix du modèle pour l’analyse de la marche, les modèles les plus complets actuels étant grévés d’une incertitude liée au placement des marqueurs trop importante. / Clinical examination and standard X-rays of the lower limbs and feet have biases related to reproducibility and to 2-dimensional projection of a 3D object. The 3Dreconstruction of the anatomical segments from biplanar images acquired in a standingposition should make possible to get rid of these biases, at the cost of moderate irradiation. The 1st part of this work asked the question of the use in current clinical practice of the reconstructions in 3D resulting from this system, and allowed validationof the reproducibility of these while giving reference values of the measured parameters in 3D. The 2nd part consisted in the adaptation of a model of reconstruction of the feet of the adult to those of the child, and aimed to check the reproducibility of the data obtained, and to report preliminary values of parameters of measurements. Finally, the 3rd part studied the feasibility of a complete analysis of pathological foot (congenital clubfoot) combining clinical examination, radiological morphology (EOS® images) andfoot function with gait analysis. We conclude that while this combined analysis appears to be critical, difficulties remain, particularly in the choice of the model for walkinganalysis, with the current full-scale models being overwhelmed by uncertainty related tothe placement of markers.